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See a sample rate comparisonMS-DRG 115 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
EXTRAOCULAR PROCEDURES EXCEPT ORBIT
| Key Fact | Detail |
|---|---|
| Service Type | Diseases & Disorders of the Eye |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Complexity Level | High |
National average reimbursement for MS-DRG 115 by major payers:
$16,600.73
$20,365.05
$24,044.34
$24,921.71
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MS-DRG 115
5 of 25 sample ratesHigher to lower in this preview
Valley Baptist Medical Center
$50,314.10Published rateMemorial Hermann Health System, Memorial Hermann Hospital
Memorial Hermann Health System
$31,434.74Published rateFlushing Hospital Medical Center
Flushing Hospital & Medical Center
$25,221.68Published rateFranciscan Health Dyer & Hammond, Franciscan Health Hammond
$17,949.68Published rateNatchitoches Parish Hospital Service District, Natchitoches Regional Medical Center
Natchitoches Regional Medical Center
$1,829.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalMS-DRG 115 vs. Other Diseases & Disorders of the Eye Codes
The MS-DRG 115 code is part of the Diseases & Disorders of the Eye services . It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The MS-DRG 115 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 114-APR-DRG | High | DENTAL DISEASES & DISORDERS |
| 114-MS-DRG | High | ORBITAL PROCEDURES WITHOUT CC/MCC |
| 115-MS-DRG | High | EXTRAOCULAR PROCEDURES EXCEPT ORBIT |
| 116-APR-DRG | Moderate | Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including MS-DRG 115. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 115 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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